An old Zen Buddhist saying cautions, “Do not mistake the finger pointing at the moon for the moon.” By focusing too much on the means, one can lose sight of the ends.
A case in point is UK Prime Minister Boris Johnson’s ambitious £100 billion ($130 billion) “Operation Moonshot” to boost the country’s COVID-19 testing capacity from 350,000 per day to ten million per day by next spring. Owing to its design, Johnson’s plan is at best a distraction from his government’s ongoing failure to implement an effective test-and-trace system; at worst, it represents a conscious effort to undermine the public sector.
To be sure, a moonshot is long overdue. Governments absolutely must adopt a mission-oriented approach to address major collective challenges like climate change and the COVID-19 pandemic. A well-designed universal testing plan with a robust test-and-trace component is the key to opening the economy safely, just as widespread mobilization of industrial production will be crucial for the economic recovery.
But the Johnson government’s plan raises concerns. First, by focusing so much on the sheer volume of tests, it ignores the central purposes of testing: to diagnose individuals, trace their contacts, and determine infection rates within the community. For assessing the spread of a virus within a given area, access to an unbiased, reasonably sized sample is far more important than the absolute number of tests performed.
Moreover, universal testing of everyone raises the specter of false positives. As the government’s own statistical adviser, David Spiegelhalter, has pointed out, a 99% accurate test of ten million people per day will yield 100,000 false diagnoses daily, sowing confusion and potentially misdirecting health services. By putting quantity before quality, the government’s moonshot planners appear not to have consulted with the UK National Screening Committee.
A second problem concerns feasibility. Under the plan, the government would continue to rely on profit-maximizing companies to achieve the necessary testing capacity. But why should anyone expect companies that failed to deal with a surge in testing from 700 to 7,000 per day be able to manage ten million per day?
As Theodore Agnew of the Cabinet Office and Treasury recently noted, such outsourcing has already “infantilized” the government and resulted in low-quality delivery. In fact, outsourcing COVID-19 testing has created as many problems as it has solved, including poor quality control, a lack of data alignment with primary-care physicians, and barriers to access for patients (with many having to drive for miles).
Given these obvious flaws, the government’s plan looks like another missed opportunity. A far better approach would be to give testing contracts to local public-health authorities and primary-care providers with the necessary expertise and trust of their respective communities.
Every general practitioner has nasal swabs, and could be equipped to offer testing services within a mile of where people live. Nurses and other trained personnel could collect samples from the surrounding community and use their standard designated courier services to submit the tests to National Health Service labs, which follow proper procedures, unlike the labs run by accountancy firms.
Ignoring these options, the government has resorted to blaming others (currently “young people”) when things go awry, even though the public has been simply adhering to official advice. If communities were updated frequently on the state of the virus in their own area, as has been done in countries like South Korea and Norway, they would be far more likely to adhere to safety protocols and trust public authorities. The United Kingdom has failed to do this, and also has not made good use of the 750,000 people who have volunteered to support local contact-tracing efforts.
So, while the government is showing appropriate ambition, its actual approach leaves much to be desired. By exploiting the rhetoric of a “moonshot,” Johnson has done a great disservice to those who are working hard behind the scenes on credible plans to mitigate the worst effects of the pandemic.
Worse, by neglecting the essential philosophy of a mission-oriented approach – which aims to create dynamic public-sector capabilities to serve common goals – the government could end up further undermining public health.
At £100 billion, the cost of the plan amounts to 87.7% of NHS England’s total budget of £114 billion.
Rather than being used to back local efforts, improve testing access, provide financial support to those in self-isolation, and integrate national and local health systems, these funds will likely be fed into a parallel, outsourced system run by consulting firms that are not fit for purpose.
Just when it is needed most, the UK’s public-health leadership has been thrown into turmoil by the abolition of Public Health England and the establishment of a National Institute for Health Protection (bringing together Public Health England, NHS Test and Trace, and the Joint Biosecurity Centre).
This new body has been placed under the interim leadership of Baroness Dido Harding, a politician with no formal public-health training.
A chronic lack of public investment has resulted in a health crisis that is much worse than it needs to be.
The UK needs more public-sector capacity, not more outsourcing. While Johnson looks at his finger, his moonshot is barreling off in the wrong direction. The UK public deserves a stronger health system.
That is the “moon” we should be shooting for. Achieving a safe and timely landing will require a combination of bottom-up, cross-sectoral innovation and effective central coordination.
The two authors will be hosting a global event at University College London on Monday, October 19, about health, inequalities, and the Sustainable Development Goals. You can sign up here to watch live.
Mariana Mazzucato, Professor in the Economics of Innovation and Public Value at University College London and Founding Director of the UCL Institute for Innovation and Public Purpose, is the author of The Entrepreneurial State: Debunking Public vs. Private Sector Myths (2013) and The Value of Everything: Making and Taking in the Global Economy (2018). Anthony Costello is Professor of Global Health and Sustainable Development at University College London and a former director of maternal and child health at the World Health Organization.
Copyright: Project Syndicate, 2020.